先天性主动脉-左心室通道影像诊断及误诊分析

目的探讨超声心动图结合CT对主动脉-左心室通道(ALVT)的诊断价值及误诊分析。方法 2010年8月至2014年10月于武汉亚洲心脏病医院诊断并手术治疗的ALVT患儿共5例,对其超声心动图及CT图像进行回顾性分析。结果超声心动图将4例患儿诊断为主动脉-左心室通道,二维超声心动图可清楚显示主动脉根部与左心室之间的异常交通,彩色多普勒可见收缩期左心室血流经主动脉开口和ALVT同时进入主动脉,舒张期可见血流经ALVT反流入左心室。4例患儿中有2例为主动脉瓣二瓣化,1例有主动脉瓣反流。根据Hovaquimian分型:超声心动图诊断的4例病例中,Ⅰ型和Ⅱ型各2例。1例患儿超声误诊为左冠状动脉-左心室瘘。行CT检查的3例患儿,2例诊断为主动脉-左心室通道,1例误诊为左冠状动脉-左心室瘘。结论超声心动图结合CT检查是诊断主动脉-左心室通道的可靠手段,可为选择治疗方案及评价预后提供重要依据。     

术中经食管超声心动图在主动脉-左心室异常通道诊断及治疗中的应用

目的 探讨及总结经食管超声心动图在主动脉-左心室异常通道诊断及治疗中的应用价值.方法 回顾性分析7例主动脉-左心室异常通道患者,包括先天性主动脉-左心室隧道4例,获得性主动脉-左心室异常通道3例,包括主动脉瓣置换术后主动脉瓣旁的主动脉与左心室间的异常交通合并机械瓣瓣周漏2例,室间隔缺损修补术后残余分流、主动脉与左心室异常交通合并主动脉瓣穿孔1例.7例患者体外循环前后均即刻行经食管超声心动图检查,全面评价主动脉-左心室异常通道的形态,主动脉瓣受累情况、机械瓣瓣周漏情况及升主动脉等周边结构的形态及功能.结果 7例患者术中经食管超声均正确诊断,并准确显示7例主动脉-左心室异常通道的交通口位置、直径、隧道宽度、长度、走形及与邻近结构关系等解剖信息.2例患者合并升主动脉扩张.1例主动脉瓣无冠瓣和左冠瓣发育欠佳,主动脉瓣少、中量反流,1例主动脉瓣穿孔患者主动脉瓣中大量反流.2例机械瓣瓣周漏患者瓣周少、中量反流.手术包括单纯闭合主动脉-左心室隧道、主动脉瓣位机械瓣置换、主动脉瓣成形等.术后经食管超声心动图即刻评价主动脉-左心室异常通道的闭合情况、主动脉瓣机械瓣的功能、成形术后自体主动脉瓣的功能,保证了手术效果.结论 术中超声心动图能为外科医师提供主动脉-左心室异常通道及周边结构受累的详细解剖及功能信息,并可及时、准确地评价通道闭合情况和主动脉自体瓣或机械瓣功能等手术效果.     

超声心动图在左室-右房通道诊治中的应用价值

目的探讨超声心动图在左室-右房通道诊治中的应用价值。方法回顾性分析我院4例左室-右房通道患者的术前超声特点、术中超声引导以及术后超声评估情况。结果 4例左室-右房通道患者中,2例为先天性,2例为获得性,皆继发于室间隔缺损修补术后。术前4例患者经胸超声心动图均探及三尖瓣隔瓣附着点与二尖瓣前瓣附着点之间回声中断,彩色多普勒显示一高速血流束由左室经交通口流入右房。实时三维超声心动图清晰显示缺损的形态、大小及毗邻关系。其中3例患者在超声引导下行介入封堵术,术后即刻经食管超声示封堵器未见移位,左室-右房分流消失。结论超声心动图不仅是诊断左室-右房通道的首选方法,而且能实时引导封堵、监测及评估疗效。实时三维超声心动图能更准确、直观地显示其解剖结构,对于手术方式及封堵器型号的选择起着至关重要的作用。     

主动脉左室隧道彩色多普勒超声心动图图像特征研究

目的:探寻主动脉左室隧道(ALVT)彩色多普勒超声心动图(CDE)图像特征。方法:应用CDE检查7例ALVT,寻找ALVT图像特征。7例均经心血管造影对照,5例手术证实。结果:根据CDE图像特征对5例做出正确诊断,1例误诊为左冠状动脉左室瘘,另1例误诊为主动脉瓣狭窄并关闭不全。CDE图像特征明显:①二维超声心动图(2DE)胸骨旁左室长轴切面在主动脉前壁或后壁显示一管状无回声腔与左室流出道相通。彩色多普勒血流显像(CDFI)显示收缩期血流信号从左室流出道进入无回声腔;舒张期血流信号从无回声腔进入左室流出道。②2DE胸骨旁大动脉短轴切面在主动脉窦与主动脉壁之间显示一半月状或新月状无回声腔。CDFI在无回声腔内显示血流信号。③绝大多数病例都合并主动脉瓣发育不全和主动脉瓣关闭不全,半数病例合并二尖瓣关闭不全,个别病例合并室间隔缺损。结论:ALVT的CDE图像特征明显,CDE对ALVT有特异性诊断价值,但需与冠状动脉瘘、主动脉夹层动脉瘤和主动脉瓣关闭不全鉴别。     

主动脉左室隧道的彩色多普勒超声诊断价值及误诊分析

目的观察彩色多普勒超声诊断主动脉左室隧道的声像图特征,分析术前超声误诊原因,提高彩色多普勒超声对主动脉左室隧道诊断的准确度。方法回顾性分析经手术证实7例主动脉左室隧道患者的彩色多普勒声像图资料。结果术前超声诊断正确5例(71.4%),误诊2例(28.6%)。根据Hovaguimian法分型本组病例Ⅰ型4例(57.1%),Ⅱ型3例(42.9%)。超声特异度表现为升主动脉与左室流出道之间,主动脉旁异常管道状结构,彩色多普勒显示收缩期血流信号自左室流出道经管道进入升主动脉,舒张期血流信号自升主动脉经管道反流回左室流出道。结论主动脉左室隧道具有特异度彩色多普勒声像图特征,彩色多普勒超声可作为临床诊断和鉴别诊断主动脉左室隧道重要检查方法。     

主动脉右冠瓣与无冠瓣交界处血流加速的超声观察及血流动力学分析

目的 超声观察主动脉右冠瓣与无冠瓣交界处血流加速,并结合心脏形态学及血流动力学分析其形成机制.方法 37例主动脉右冠瓣与无冠瓣交界处血流加速者为观察组,35例健康志愿者为对照组.用彩色多普勒于主动脉根部短轴切面显示收缩期主动脉瓣口血流信号;测量实验组及对照组左室腔与左室流出道中轴线的夹角;用脉冲多普勒测量主动脉瓣及左室流出道收缩期峰值流速.结果 观察组的主动脉右冠瓣与无冠瓣交界处收缩期彩色血流信号显示明亮、部分呈湍流.观察组与对照组心尖五腔切面左室腔与左室流出道二者中轴线的夹角分别为128°±15°及145°±13°(P＜0.01);心尖三腔切面左室腔与左室流出道二者中轴线的夹角分别为126°±19°及141°±16°(P＜0.01).与对照组相比,观察组由左室到主动脉瓣的空间心腔轴线变化幅度增大,主要表现为前后方向的变化幅度增大.结论 主动脉右冠瓣与无冠瓣交界处的血流加速与左室腔、左室流出道夹角变小所致的主动脉瓣口血流速度不均匀,并与主动脉右冠瓣与无冠瓣交界处所处的方位有关.     

超声心动图对儿童左冠状动脉起源异常的诊断分析

目的 探讨超声心动图对儿童左冠状动脉起源异常如何早期正确诊断及其临床价值.方法 以经冠状动脉造影、CT重建或手术证实的7例左冠状动脉起源异常患儿为研究对象,回顾分析其超声心动图特点、鉴别诊断要点及误诊原因.结果 7例左冠状动脉起源异常患儿,超声心动图确诊4例,2例误诊为心内膜弹力纤维增生症,1例漏诊,超声表现为各切面均未见左冠状动脉开口于主动脉左冠窦,右冠状动脉开口于主动脉右冠窦,肺动脉根部后壁、左前壁或右冠状动脉主干发出左冠状动脉,部分病例肺动脉内见异常血流信号.结论 超声心动图能够早期准确诊断儿童左冠状动脉起源异常,关键是对本病有充分的认识,其方法既无创又有较强的重复性,对尽早手术治疗提高患儿的生存率具有重要的临床意义.     

超声心动图在经导管主动脉瓣置换术中的应用价值

目的 探讨超声心动图在主动脉瓣膜病变患者经导管主动脉瓣置换术（TAVR）的术前评估、术中监测及术后随访中的应用价值。方法 回顾性分析我院收治的32例行TAVR的主动脉瓣膜病变患者的临床资料，分为单纯主动脉狭窄患者13例（Ⅰ组），单纯主动脉瓣反流患者6例（Ⅱ组），主动脉瓣狭窄合并反流患者13例（Ⅲ组）。分析各组术前多层计算机断层扫描（MSCT）对主动脉根部结构测值、术前及术后1个月超声心动图参数的差异，以及术中情况、术后并发症发生情况。结果 32例患者术中均经股动脉植入瓣膜，并应用经食管超声心动图（TEE）监测，其中2例于TEE引导下行房间隔穿刺逆行跨主动脉瓣，4例采用瓣中瓣手术。术前实时三维经食管超声心动图（RT-3D TEE）与MSCT测得的主动脉瓣环最大径、最小径、面积、周长，以及左、右冠状动脉开口高度比较，差异均无统计学意义。术后即刻TEE评估：少至中量瓣周漏4例，少量瓣周漏9例，微量瓣周漏5例，无瓣周漏14例。经胸超声心动图结果显示，与术前比较，Ⅰ组术后1个月主动脉瓣峰值流速（AV Vmax）、主动脉瓣平均跨瓣压差（AVPGmean）、室间隔厚度（IVST）、左室后壁厚度（PW...     

超声心动图对干下型室间隔缺损合并主动脉瓣下隔膜及主动脉瓣关闭不全的诊断价值

目的 总结先天性干下型室间隔缺损合并主动脉瓣下隔膜及主动脉瓣关闭不全的超声心动图特征,并探讨超声心动图对本病的诊断价值.方法 入选15例干下型室间隔缺损合并主动脉瓣下隔膜及主动脉瓣关闭不全患者,超声心动图检测室间隔缺损与主动脉瓣下隔膜的关系,室水平分流特点,主动脉瓣下隔膜引起狭窄的程度,主动脉瓣关闭不全的程度,分析它们之间的相互关系及血流动力学特点.结果 (1)室水平分流频谱为收缩及舒张期连续性左向右分流.(2)主动脉瓣关闭不全的程度与室间隔缺损的大小呈正相关性(0.001＜P＜0.002 5).(3)术前超声测量室间隔缺损数据组比术中实际值小,P＜0.05差异有统计学意义.结论 超声心动图对先天性干下型室间隔缺损合并主动脉瓣下隔膜及主动脉瓣关闭不全的患者,具有较高且独特的诊断价值.     

超声心动图评估新型主动脉人工瓣膜Perceval Sorin

目的 探讨超声在新型主动脉人工瓣膜Perceval Sorin临床试验研究中的应用价值.方法 术前、术中、术后7 d和术后1个月,使用经胸超声心动图及经食管超声心动图检查经主动脉瓣及人工瓣膜Perceval Sorin的血流速度曲线,记录最大跨瓣压差和平均压差,彩色多普勒判断主动脉瓣反流程度,术后有无瓣周漏.结果 15例患者术前均患有中-重度主动脉瓣狭窄,Perceval Sorin置换后,主动脉跨瓣平均压差(12.57±1.99)mm Hg(1 mm Hg=0.133 kPa),瓣口面积(1.37±0.28)cm~2.无瓣周漏,1例(1/15)患者术后主动脉瓣口少量反流,余患者术后主动脉瓣口微量反流或未见反流.结论 Perceval Sorin置换手术后,术后主动脉跨瓣压差明显减低,瓣口面积明显增大.超声心动图能及时准确评价治疗效果,提供有价值的信息.     

多巴酚丁胺负荷超声心动图对低压力阶差低心排血量主动脉瓣狭窄的研究

目的 评价负荷超声心动图技术在诊断低跨瓣压力阶差-低心排量主动脉瓣狭窄中的作用。方法 对经临床拟诊和经胸超声心动图（TTE）确定为低跨瓣压力阶差-低心排量主动脉瓣狭窄的12例患者进行回顾性分析,并均行多巴酚丁胺超声心动图负荷试验予以确定病变性质。结果 8例患者呈重度主动脉瓣狭窄伴左心功能不全,左室有收缩储备,外科手术换瓣均成功（除1例死亡外）;其余4例予内科药物治疗。结论 多巴酚丁胺超声心动图负荷试验对鉴别低跨瓣压差低心排的主动脉瓣狭窄是有效、安全的方法。     

Biatrial compression caused by intrapericardial hematoma secondary to ruptured type I acute aortic dissection following aortic valve replacement

Ruptured aortic dissection after aortic valve replacement (AVR) is uncommon and rarely diagnosed premortem. We report a patient with a ruptured type I aortic dissection and biatrial tamponade 2 months after AVR caused by loculated intrapericardial hematoma.The diagnosis was made by transthoracic echocardiography and confirmed at operation.     

感染性心内膜炎的诊治

目的：介绍对感染性心内膜炎的及时诊断和治疗选择的体会，方法：根据症状，体征，血培养，心脏超声等综合分析。做出诊断，分别进行手术及药物治疗。结果：10例感染性心内膜炎药物治愈2例。手术治疗8例，治愈5例，手术死亡3例。其中2例因感染导致瓣周漏致左心功能严重损害，1例因再交感染致主动脉瓣及升主动脉坏死。结论：感染性心内膜炎药物保守治疗效果不佳者应尽早手术治疗，可得到满意效果。对感染引起的瓣周漏致左心功能不全者应立即果断进行手术治疗。反之则会引起严重后果。     

Cloth tears in asymptomatic survivors of aortic valve replacement with Starr-Edwards prostheses: detection by transesophageal echocardiography.

Cloth-covered Starr-Edwards valves were withdrawn in the 1970s because of complications of cloth tear. Nevertheless, many patients are still alive with their prosthesis in place. We evaluated the ability of transesophageal echocardiography (TEE) to detect cloth tear in 9 asymptomatic patients operated on with a cloth-covered Starr-Edwards aortic valve at our institution.An echogenic mobile structure attached to the prosthesis, suggestive of a tear, was detected in 5 patients (55%). A tear was diagnosed in a sixth patient when TEE was repeated during follow-up because of neurologic symptoms. In all cases, transthoracic echocardiography failed to detect any abnormality. Two patients had symptoms develop and underwent reoperation; cloth tear was more extensive than suspected by TEE.Cloth tear is a frequent finding that can be detected by TEE in asymptomatic patients with cloth-covered Starr-Edwards aortic prosthesis. TEE is recommended in these patients and reoperation should be considered as soon as symptoms appear.     

Ultrasound evaluation of aortic valve anatomy in the fetus.

OBJECTIVE: To assess the feasibility of ultrasound identification of aortic valve anatomy in the fetus, with particular emphasis on the detection of bicuspid aortic valve. METHODS: This study was a prospective analysis of 21 fetuses with prenatally diagnosed congenital left heart obstructive lesions and 45 normal fetuses undergoing routine ultrasound evaluated at a tertiary referral center. These fetuses underwent detailed echocardiography, including the study of the aortic valve on a targeted short-axis view of the right ventricle. Necropsies or postnatal echocardiograms were available for confirmation of the diagnosis in all cases. RESULTS: Aortic cusps and commissures were satisfactorily visualized in 38/45 (84%) normal fetuses and in 18/21 (86%) fetuses with congenital heart disease. The aortic valve was correctly defined as bicuspid in one normal fetus and in six fetuses with congenital heart disease. In two fetuses with a positive family history, the bicuspid aortic valve was isolated. There was one incorrect diagnosis (a unicuspid unicommissural valve diagnosed prenatally as a bicuspid aortic valve in a fetus with severe aortic stenosis) and one false-positive diagnosis in a fetus diagnosed with a coarctation and a bicuspid aortic valve late in the third trimester of pregnancy and in which both anomalies were not confirmed at neonatal echocardiography. CONCLUSIONS: This study demonstrated that aortic valve anatomy can be satisfactorily assessed in fetuses with and without left heart obstructive lesions. We believe that a detailed search for a bicuspid aortic valve should be attempted in all patients referred for a positive family history of congenital heart disease, in general, and of left ventricle outflow tract obstruction or bicuspid aortic valve, in particular. In fact, the presence of an asymptomatic bicuspid aortic valve has been demonstrated to represent an important factor predisposing to the development of bacterial endocarditis and dissecting aortic aneurysm late in adult life. Therefore, an early detection of such an anomaly may contribute to ensure a longer symptom-free lifespan of individuals with the most common cardiac anomaly at birth.     

小儿先天性主动脉瓣上狭窄的超声诊断

目的 探讨小儿先天性主动脉瓣上狭窄(SVAS)的超声心动图特点及其诊断价值.方法 超声心动图在多个切面上检查诊断为主动脉瓣上狭窄的31例息儿,与心导管、手术及基因检测相对照.超声重点观察主动脉瓣、瓣上、主动脉弓降部、肺动脉瓣、主肺动脉及其左右分支、冠状动脉的超声改变.结果 沙漏样环形狭窄26例,全段管型狭窄4例,隔膜型狭窄1例.极轻度狭窄[狭窄处的最大瞬时压差(△P)<25 mm Hg(1 mm Hg=0.133 kPa)]2例,轻度狭窄(△p 25～49 mm Hg)20例,中度狭窄(△P 50～75 mm Hg)5例,重度狭窄(△P>75 mm Hg)4例.19例患儿基因检测诊断为Williams综合征.合并主动脉瓣狭窄3例,其中1例首次检查时漏诊.合并肺动脉狭窄10例,占32.26%.其中肺动脉瓣狭窄6例,左、右肺动脉狭窄3例,左右肺动脉分叉处狭窄1例.合并冠状动脉扩张6例.结论 胸骨旁及心尖五腔切面为诊断SVAS较好的切面,SVAS好发于Williams综合征的患儿,32.26%的患儿伴有肺动脉狭窄.对于SVAS患儿需常规检查冠状动脉的改变.     

Clinical and echocardiographic evaluation of mitral valve aneurysms: a retrospective,single center study

Mitral valve aneurysms (MVAs) are rarely encountered in echocardiography laboratories. Although they are commonly associated with endocarditis of the aortic valve, various mechanisms have been suggested for the etiopathogenesis of MVAs associated with non-infectious conditions. 5,887 patients who underwent transesophageal echocardiography (TEE) between 2007 and 2012 were evaluated retrospectively for MVA. Mitral valve aneurysm is defined as a localized saccular bulging of the mitral leaflet towards the left atrium with systolic expansion and diastolic collapse. The color flow Doppler image of a perforation was described as a high-velocity turbulent jet traversing a valve leaflet in systole. We found that 12 of 5,887 patients (0.204 %) had MVA in TEE examinations. The mean age of patients with MVA was 53 years (range 21–80 years), including four females and eight males. Nine patients presented with symptoms of endocarditis. On TEE, aneurysms were located in the anterior mitral leaflet in 11 patients, and in the posterior mitral leaflet in one patient. Eight patients had severe, three had moderate, and one had trace mitral regurgitation. Of the nine patients with perforated leaflets, eight patients had severe and one patient had moderate mitral regurgitation. Aortic regurgitation was present in nine patients, being severe in three, moderate in two, mild in two, and trace in two patients. Two patients without severe mitral regurgitation were followed-up conservatively, while nine patients underwent surgery. Two patients died from septic shock, one in the postoperative period and the other one prior to surgery. Although MVAs occur during the course of aortic valve endocarditis and, in particular, due to aortic regurgitation jet, it should be borne in mind that they may develop as an isolated valvular pathology and may be misdiagnosed as chordal rupture, other cardiac masses, or vegetation. Thus, MVAs may not be so infrequent as they are thought; they may justify to be considered in the differential diagnosis of masses seen on the mitral valve on echocardiographic examination.     

超声诊断胆道蛔虫症并肝内多发脓肿1例

患者女性,４３岁。右上腹持续疼痛十天,畏寒发热,体温最高３９．６℃,多次呕吐蛔虫体,共约十条。体检：一般情况差,右上腹肌紧张,无明显压痛及反跳痛,墨菲氏征阳性。血常规：白细胞１７．８Ｇ／Ｌ,中性粒细胞８７．１％,淋巴细胞１２．９％。超声检查：肝脏增大...     

超声心动图用于心尖入路经导管主动脉瓣植入术

目的 评价超声心动图用于心尖入路经导管主动脉瓣植入术(TAVI)的价值.方法 纳入23例接受J-Valve TAVI的主动脉瓣疾病患者,根据主要疾病,将其中20例非重度主动脉瓣狭窄(AS)合并中度以上主动脉瓣反流(AR)者分为AS组(n=10)及AR组(n=10).术前行经胸超声心动图(TTE),术中全程以经食管超声心...     

实时三维超声心动图诊断二叶主动脉瓣畸形

目的 探讨实时三维超声心动图(RT-3DE)评价二叶主动脉瓣(BAV)畸形的应用价值。 方法 应用经胸二维超声心动图(2DE)和RT-3DE对41例BAV患者进行诊断,并与手术结果对照。 结果 经RT-3DE检查的41例患者与手术结果一致,其中横裂式25例、纵裂式10例、斜裂式6例;经2DE检查的30例患者与手术结果一致。2例患者2DE观察不清晰的赘生物,RT-3DE显示为附着于主动脉瓣叶心室面的赘生物。 结论 RT-3DE能够快速、直观、准确显示瓣膜结构,在BAV的诊断中可获得较2DE更丰富的空间信息,具有重要应用价值。